Vision and Ocular Surface Salvage in Extreme Postburn Cicatricial Ectropion With Infectious Exposure Keratitis

Abstract

Prevention and early management of post-burn cicatricial ectropion is the best strategy to avoid ocular complications, with poor visual prognosis in extreme cases. A 51-year old man presented with diminution of vision and absolute inability to close both eyes, three months after thermal burn injuries to face, upper limbs and trunk. His best corrected visual acuity (BCVA) was 1/60 in BE. He had bilateral extremely severe ectropion involving both upper and lower lids with complete inability to close the eyes. The ensuing exposure keratitis developed secondary infection by Methicillin resistant Staphylococcus aureus (MRSA) in the right eye and multi-drug resistant Pseudomonas aeruginosa in the left eye. His extreme ectropion prevented infection healing, so its release and full-thickness skin grafting was done when partial resolution of infection was noted. After three months, he had moderate residual ectropion in BE; vascularised corneal scar in the inferior part of the right eye (BCVA:20/40) and adherent leucoma in left eye (BCVA:HM). Prioritising ectropion surgery in our extreme case for infection control, facilitated corneal healing. Our case highlights the extreme consequences of not taking preventive measures or of managing incident ectropion following thermal injury to the face.